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Open wide! More senior citizens opt for braces

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Sybil Brown, 75, of Seattle, wears ceramic braces on her top teeth and standard metal braces on her bottom teeth. (Shannon Prophet/Courtesy of Dr. Don Joondeph)

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This side-by-side comparison of braces old and new illustrates the technological advances of the first 100 years of orthodontics. At left is a set of full-banded braces, circa 1929, fashioned from gold (on the top teeth) and metal. Today, brackets can be translucent, with heat-activated nickel-titanium wires developed through NASA, as shown at right. (Courtesy of the American Association of Orthodontists)

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A patient shows off a pair of ceramic braces. (Courtesy of the American Association of Orthodontists)

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This image shows fully banded braces, circa 1970, with each tooth encircled by a metal band. Today, orthodontists bond brackets directly onto the teeth. ****Please note small file size: 1600 pixels by 1200 pixels.**** (Courtesy of the American Association of Orthodontists)

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A patient shows off silver brackets with green rubber bands for St. Patricks Day. (Courtesy of the American Association of Orthodontists)

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A patient has gold braces. ***Please note small file size: 1272 pixels by 708 pixels*** (Courtesy of the American Association of Orthodontists)

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A 66-year-old patient wears translucent brackets. (Michael B. Rogers, D.D.S., P.C./Courtesy of the American Association of Orthodontists)

Sybil Brown, 75, a retired school principal from Seattle, had always been proud of her straight, perfect teeth. But one day her precocious 12-year-old granddaughter, Lindsey, noticed one of Brown’s bottom teeth starting to jut toward her lip. “Grandma,” the girl declared, “you should go to my orthodontist.”

At first Brown laughed it off, but a glance in the mirror revealed that her granddaughter was on to something. Now, she and Lindsey share more than a gene pool; they also share the same Bellevue, Wash., orthodontist.

Orthodontic treatment used to be limited mostly to teenagers, but more than 1 million adults--who make up about 20 percent of orthodontic patients--now have braces, according to the American Association of Orthodontists. Among the grown-ups, Brown is part of a steadily expanding subset: people in their 60s, 70s and 80s who are straightening their teeth. As rates of toothlessness decline and people live longer, more seniors are saying no to dentures and yes to the orthodontist's chair.

While survey data aren't available on the number of patients over 50, orthodontists say they’re seeing more patients in their golden years. Dr. Don Joondeph, president of the American Association of Orthodontists, said he had six to eight patients between 70 and 80 and “two or three dozen” who are over 60. “People are healthier longer,” he said. “A patient who comes in at 60 could have 30, 40 years ahead of them. They’re making a good investment for their health.”

William Davidson, an orthodontics professor at the University of Maryland Dental School, agreed: “I put this in the same category as the older population at the health club. They’re running, taking supplements. They’re just doing more things for themselves.”

Orthodontic improvements over the past two decades have helped make braces more appealing to adults. In the past, brackets were held in place by metal bands. Now, they’re bonded to the front of the teeth. There are low-visibility white ceramic braces, clear Invisalign retainers and lingual braces, which are mounted on the inside of the teeth so they can’t be seen at all. And heat activated nickel-titanium wires now make orthodontic treatment faster and more comfortable, doctors said.

Patients of any age can wear braces so long as they have healthy bones and tissues, Joondeph said. But in the past, the elderly tended to be missing one important requirement: teeth. With few treatments for tooth decay and gum disease, previous generations began losing teeth by age 40.

But improvements in preventative dentistry, including the advent of fluoride toothpaste, have dramatically slowed that trend. The rate of toothlessness in people aged 55 to 64 has dropped 60 percent since 1960, according to the American Dental Association.

These days, the elderly want--and expect--to keep their natural teeth, and braces can help them do that. Ruth Thayer, 64, a certified healing touch practitioner from Lorain, Ohio, started to worry when her younger brother began losing his teeth. The two hadn’t worn braces as children, and they both had the same crowded configuration of difficult-to-clean teeth.

Thayer’s overlapping bottom teeth had begun tilting forward, and she was advised to have them pulled and replaced with a bridge.

“I said no way,” Thayer recalled. Instead, she opted to spend a year wearing braces on her lower teeth to return her pearly whites to their proper alignment. Once they’re straight, they’ll also be easier to brush and floss.

Thayer’s refusal to accept false teeth is common in an age where many people are embarrassed to wear dentures, Joondeph said. Patients today also are a lot more proactive. “In other generations people would say, ‘I’m too old for this. I’m just gonna let it go,’” he said. “People these days are much more health conscious and would much rather keep their teeth forever. Loosing teeth is a last alternative.”

Many seniors can benefit medically from orthodontic treatment, but aesthetics also play a role in the decision-making process. That was the case for Brown, one of Joondeph’s patients, who has worn $7,000 worth of braces, ceramic on the top and regular metal on the bottom, for a year and a half.

After her granddaughter’s comment, Brown scrutinized her smile and worried that the jutting tooth would get worse. “I’ve seen older people with a tooth hanging out of their mouth and I thought, ‘Oh no, I can’t look like that,’” she said.

The expensive treatment was a major investment for Brown, whose insurance only covered about $1,500 of the cost. But she felt it was worth it to keep her smile in tip-top shape. “I’ve always liked my teeth,” she said, “And I’m going to protect them.”

Braces certainly aren’t for everyone. Considered an elective procedure by many insurance companies, braces generally cost between $1,000 and $8,000, making them too expensive for many seniors.

Cancer survivors and osteoporosis patients should be especially careful before undergoing dental procedures, experts said. A group of bone-strengthening medications, bisphosphonates, have recently been associated with a painful condition called osteonecrosis of the jaw, also known as “jaw death.” Doctors believe that invasive dental procedures, like tooth extractions and implants, may be linked to the condition. Patients taking bisphosphonates are urged to inform their doctors before undergoing dental or orthodontic procedures.

Even when conditions are optimal, braces aren’t exactly fun, as any 12-year-old can attest. Though Thayer now thinks of her braces as “jewelry for the mouth,” her first reaction to them was “horror and embarrassment,” she said. Plus, the constant pressure on her lips and cheeks can be irritating.

Brown, too, said she was mortified when, on a cruise last April, she first saw pictures of herself with braces. But she’s staying focused on the day--only a few months from now--when they’ll come off.

The first thing she’ll do after getting them removed is “sit in front of the computer and take pictures of myself,” she said with a chuckle. “A whole bunch of them.”

E-mail: cet2111@columbia.edu